[HN Gopher] The illusion of evidence based medicine
___________________________________________________________________
The illusion of evidence based medicine
Author : pueblito
Score : 104 points
Date : 2022-03-24 17:59 UTC (5 hours ago)
(HTM) web link (www.bmj.com)
(TXT) w3m dump (www.bmj.com)
| tensor wrote:
| Drug company bias is definitely a well known issue. But there are
| even bigger issues with science based medicine.
|
| * MDs are not PhDs for one, though people often equate the two.
|
| * Things like surgery is in fact hard to test. There are ethical
| issues around it. E.g. are you really going to do a shame surgery
| "for science" if you think there is a chance it might save the
| patients life? On the flip side, surgery has a lot of risk, and
| performing surgery that doesn't work exposes patients to
| unnecessary risk.
|
| * There are entire fields where pseudo-science is common. Notably
| a lot of physical therapy and chiropracty is not science based.
| willhinsa wrote:
| On the difficulty of testing lifesaving treatments, there's a
| great paper on this topic:
|
| "Parachute use to prevent death and major trauma related to
| gravitational challenge: systematic review of randomised
| controlled trials" [0]
|
| It has some great gems like: - No randomised
| controlled trials of parachute use have been undertaken
| - The basis for parachute use is purely observational, and its
| apparent efficacy could potentially be explained by a "healthy
| cohort" effect - Individuals who insist that all
| interventions need to be validated by a randomised controlled
| trial need to come down to earth with a bump
|
| [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/
| slibhb wrote:
| I think profit motive and regulatory capture are real problems
| but I don't think they're the only problems and maybe not the
| biggest.
|
| For example, the FDA is generally agreed to have dropped the ball
| by dragging its feet on approving covid tests. I don't think
| profit motive or regulatory capture explain that. What does?
|
| More transparency (as the authors recommend) sounds great but
| giving more power to regulatory bodies is no panacea.
| ouid wrote:
| Big Pharma _derives_ its oligopoly from the barriers to entry
| that the FDA imposes. Presumably they take every opportunity to
| lobby for more rigorous extensive testing. Not because they
| want to pay more to run tests, but because they want their
| smaller competitors to pay more to run studies for drugs that
| might compete.
|
| This is, of course, not an explanation for _how_ they have
| variously captured the components of the FDA, but it does
| explain how such a capture is an explanation for foot-dragging.
| mikekij wrote:
| > For example, the FDA is generally agreed to have dropped the
| ball by dragging its feet on approving covid tests. I don't
| think profit motive or regulatory capture explain that. What
| does?
|
| I'm no fan of over-regulation, but the FDA finds itself in an
| impossible situation: approve tests quickly to slow the spread
| of Covid, only to later find that the tests don't work, or test
| the products rigorously, while patients suffer.
|
| It's a very difficult balance to strike, and I would argue
| they've done as good a job as one could hope.
| Terry_Roll wrote:
| As someone who recently complained to the UK Royal College of
| Veterinary Surgeons and got palmed off because the UK legislation
| doesnt quantify "reasonable care", the whole system is one giant
| authoritarian money making scam.
|
| I dont know what professionals are being taught in med/vet/law
| school now a days, but technology is increasingly demonstrating
| that professionals could be out of date by the end of their
| course!
|
| So that problem of trying to stay current in IT is spreading out
| into other professions and I dont see them tackling this problem
| like the IT sector has/does.
| yes_man wrote:
| Another great argument I have heard against EBM (or maybe rather
| against being religious about it) is that the studies and papers
| held to highest regard are made in circumstances that do not
| apply to most of healthcare: the studies might be done in the
| best hospitals like Johns Hopkins, with practically limitless
| human resources for the study, and very carefully selected
| patient groups. In a normal hospital situation you won't have the
| time or the resources to dedicate the same care for each patient,
| and the patients might have other conditions (which would rule
| you out of the big studies).
|
| Still, as a layman who is not a doctor, evidence based medicine
| sounds like a good idea, but as with everything, taking it to
| extreme is probably harmful
| medymed wrote:
| Science marches on one funeral at a time, medicine marches on one
| expired patent at a time.
| tomohawk wrote:
| It's not just corruption, it is an idea that seems very correct,
| but which is subtly wrong.
|
| Take a substance like chlorine. It is put into municipal drinking
| water because it kills things - things that can kill us or harm
| us. It is credited with making municipal water a lot safer.
|
| It has been shown to be safe and effective for most people.
|
| The key is most people. Some people, at the edges of the bell
| curve, cannot tolerate chlorine. If they drink water with it, or
| bathe in water with it, it harms them. I have family members who
| have this sensitivity. Since moving to a place with well water,
| their health has improved immensely.
|
| If you were to be guided only by studies that show the safety and
| effectiveness of the chlorine treatment, then you could overlook
| the fact that some people are outliers.
|
| Evidence based medicine will guide you to things that will work
| for most people in a given situation. However, for a specific
| patient, you may need to depart from that evidence.
|
| Limiting doctors to only evidence based approaches prevents them
| from treating specific patients.
| Nuzzerino wrote:
| > Take a substance like chlorine. It is put into municipal
| drinking water because it kills things - things that can kill
| us or harm us. It is credited with making municipal water a lot
| safer.
|
| > It has been shown to be safe and effective for most people.
|
| And yet it wasn't until I was well into my 30s that I learned
| that not cleaning your shower head often enough or thorough
| enough can block the effects of the chlorine and spray
| aerosolized bacteria everywhere.
|
| It doesn't matter what kind of medicine you have when there are
| plenty of problems that would be prevented if not for the
| obscene asymmetry of information and poor cultural health
| habits. But as long as big tech continues to believe that
| steering people toward political propaganda is what's best for
| society, that will be the narrative of the day rather than real
| progress.
| nonameiguess wrote:
| The EPA guidelines limit chlorine content in potable water to 1
| PPM. That is well below the level at which even the most
| sensitive person is affected. The problem is this guideline has
| no legal enforcement mechanism, so whether or not your
| municipal water district follows it is up to them. If they're
| not, they're not practicing evidence-based anything. They're
| ignoring evidence-based guidelines for some other reason.
|
| Whether any US water district is really doing this seems
| debatable anyway. Maybe this is just a consequence of the poor
| state of search engines, but every source I can find claiming
| specific US water supplies contain unsafe levels of chlorine
| seem to be exclusively limited to companies trying to sell you
| expensive filtration systems you almost certainly do not need.
| rscho wrote:
| That some people are sensitive to chlorine should then be
| scientifically studied, to expand the knowledge on that topic.
| Counting on individual practitioners to cook up artisanal
| individualized treatment on their own is both unscientific and
| the antithesis of what you (and everyone) want.
| tricky777 wrote:
| Evidence is king.
|
| But hyphoteticaly...
|
| if I'm an outlier, and blind test is made on only me, and
| reveals that I am sensitive to chlorated water.
|
| ...I would count that as evidence based.
| tomohawk wrote:
| Where did I say a practitioner should "cook up artisanal
| treatments"?
|
| That's a strawman, for sure.
|
| Doctors have a lot of education, and gain a lot of experience
| over time.
|
| What I pointed out is that the studies are not enough. Where
| they leave off is where a doctor needs to be able to apply
| their education, experience, and knowledge of the case to
| make progress. Doctors are trained to apply scientific
| approaches to bridge the gap between the broad science and
| the individual patient. The big health co's do not like
| doctors doing this because it takes time and is expensive.
| So, they tie their hands because they only want the doctors
| to focus on the easiest fixes that solve the most problems.
| stonemetal12 wrote:
| What do you think evidence based means? There is evidence that
| some people are sensitive to chlorine. In an evidenced based
| approach it would be considered a possible cause until there is
| evidence to rule it out. If other issues present similar
| symptoms and are more likely then they should be tested and
| ruled out first.
| obscur wrote:
| Might be wrong, but I think they just mean that when you do
| large scale trials you aggregate over the population, and
| determine if the medication had a statistically significant
| effect. You can get evidence that a subgroup does not react
| well, but you might not, if that is not your focus.
|
| A key concept and solution here is 'precision medicine',
| tailoring medicine based on more precise information about
| the individual.
| dekhn wrote:
| chloramine is replacing chlorine in municipal treatment.
|
| I'd be amazed if somebody was really sensitive to chlorine, to
| the point where typical municipal water caused rashes. After
| all, all of us contain 80grams of it and consume 500mg/day.
| auslegung wrote:
| I think you're getting down-voted because yourcomment indicates
| you think this article says that doctors should only be able to
| use evidence-based approaches. That's not at all with this
| article is about.
| FabHK wrote:
| Related: The delicious paper
|
| _Parachute use to prevent death and major trauma related to
| gravitational challenge: systematic review of randomised
| controlled trials_.
|
| > the effectiveness of parachutes has not been subjected to
| rigorous evaluation by using randomised controlled trials.
| Advocates of evidence based medicine have criticised the adoption
| of interventions evaluated by using only observational data. We
| think that everyone might benefit if the most radical
| protagonists of evidence based medicine organised and
| participated in a double blind, randomised, placebo controlled,
| crossover trial of the parachute.
|
| https://pubmed.ncbi.nlm.nih.gov/14684649/
| caycep wrote:
| granted, there is the day-to-day human physician "bayesian"
| evidence-based-medicine...for better or worse...
| qnsi wrote:
| Medical industry is corruption prone.
|
| Another example: Industry sponsored conferences. Doctors are
| invited to a 3 day 4 star hotel stay to attend a conference.
| Technically, talks that are paid shilling are specially marked as
| sponsored talks.
|
| But are the other doctors, who are getting paid to speak there
| 100% independent?
|
| Will you be a 100% independent doctor after getting free
| presents?
|
| Maybe you will. But industry probably found its profitable if
| they spent millions on these kinds of conferences.
|
| Also lie repeated multiple times makes you believe in, there are
| psychological studies. So when you spend hour listening how drug
| X is gold, you might start believing its gold
| sarchertech wrote:
| My wife's a doctor and the "free presents" she's gotten from
| conferences are laughable. A 128mb flash drive and a canvas bag
| are about the best things I've seen.
|
| She's also never gotten a free hotel stay at a conference
| unless her group was paying for it.
|
| She tells me there are strict (very small) limits on gifts from
| drug companies.
| Enginerrrd wrote:
| >Will you be a 100% independent doctor after getting free
| presents?
|
| >Maybe you will. But industry probably found its profitable if
| they spent millions on these kinds of conferences.
|
| So... theoretically the industry putting on the conference is
| also pushing the state of the art pharmaceutically and believe
| that they have an improvement on the existing standard of care.
| I don't think it's got anything to do with the presents as much
| as the message.
| obscur wrote:
| Seems very unlikely to me that it would not be a combination.
| We have both rational and irrational parts, conscious and
| unconscious parts.
|
| I'd venture one does not have to look far in the anthropology
| literature to find good evidence that gifts just like other
| favors serves a function in building reciprocal
| relationships. Since it is likely so fundamental, I have a
| hard time believing it would not have any effect on the
| independence of the doctor.
| pessimizer wrote:
| Nah. Speakers fees are a way to launder direct contributions.
| There was at least one famous case where the "conference" was
| done in one of the speakers' living rooms. Imagine getting a
| speaking fee for speaking extemporaneously in a Florida hotel
| room with two pharma reps and one other doctor five minutes
| before you all leave for golf.
| nobody9999 wrote:
| >Nah. Speakers fees are a way to launder direct
| contributions
|
| The comparison to money laundering is specious, IMHO.
|
| In the US, at least, there is a database[0] of _any_ value
| (including monetary and in-kind) exchange between doctors
| and medical companies.
|
| As such, there is no "laundering" at all. All moneys and
| in-kind (hotel rooms, meals, swag, etc.) payments are
| documented and detailed.
|
| Is there an incentive for doctors to favor a particular
| pharma or medical device company based on those payments?
| Perhaps. But since (again, at least in the US) such
| payments are documented and _publicly available_ , it isn't
| some sort of secret set of payments designed to
| _surreptitiously_ co-opt doctors.
|
| Sure, some payments (my brother, a physician, received
| ~US$20,000 in 2020, mostly (~$13,000) from a single
| consulting fee.
|
| Is my brother favoring the company who paid him $13,000 in
| 2020? Maybe. But _if and only if_ their products /devices
| have clear beneficial effects over other products/devices.
|
| What's more, that $20,000 (aside from the consulting fee,
| it was food/beverage and other in-kind stuff) is a small
| fraction of his annual income and doesn't make a
| significant difference in his quality of life.
|
| As such, while there may certainly be doctors who are co-
| opted/corrupted by medical companies, assuming that the
| majority of doctors are swayed by such things is iffy at
| best.
|
| [0] https://openpaymentsdata.cms.gov/
| drewcoo wrote:
| > Medical industry is corruption prone.
|
| Corruption is incentivized in any for-profit industry.
| ipaddr wrote:
| And non-for-profit industries
| notriddle wrote:
| And groups of people who are driven by ideology, rather
| than profit.
| TeeMassive wrote:
| Here in Quebec the vaccine passport and the curfew was touted as
| the pinnacle of "following the science"(tm). Anyone contradicting
| their usefulness as effective sanitary measures were accused of
| "spreading misinformation"(tm).
|
| The curfew was implemented twice. The vaccine passport was only
| recently removed.
|
| Turns out, one FOIA request later, that they never consulted the
| data scientists of the public health institute. They made it all
| up.
| cosmotic wrote:
| This should not be considered evidence that other quack medicines
| have any superiority over modern medicine.
| trulyme wrote:
| True. It is just evidence that _sometimes_ modern medicine
| doesn 't have any superiority over quack medicines either.
| [deleted]
| tsoukase wrote:
| EBM suggests that swimming in a heated swimming pool (controlled
| studies) can be the same as swimming in open sea/ocean (applying
| the result in any possible case)
| FabHK wrote:
| The distinction you allude to is _so_ well known and understood
| that there are not only papers about it, but also special words
| to distinguish them: efficacy (performance of an intervention
| under ideal and controlled circumstances) and effectiveness
| (performance under 'real-world ' conditions).
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726789/
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912314/
| smohare wrote:
| One of the issues I've seen with EBP is that it's often not
| necessarily science based. That is to say, prior plausibility
| derived from basic science isn't fully incorporated, ergo undo
| weight is given to noise. You see with in almost any study of
| pseudoscientific modalities, where actual efficacy would require
| a drastic reformation of our fundamental, very well tested models
| of the natural world. Why should a particularly strong one-off
| result for my made up pain treatment be afforded the same stature
| as that of an pharmacological agent with clear physiological
| pathways?
| rscho wrote:
| Evidence-based medicine does incorporate prior evidence for
| causal evaluation. Check out the "Bradford criteria". They're
| the basis of causal evaluation in epidemiology.
| sammalloy wrote:
| One thing that has always stuck with me in regards to this topic
| is the lack of medical research in areas that need it but don't
| get it because there isn't any money in it. One area that comes
| to mind is feline urinary tract disease. Many years ago, I had a
| cat who kept coming down with this, and the vet(s) were at a
| total loss as to how this kept happening. So I decided to open up
| the literature and plough into it as a layman with no knowledge
| about animal medicine. Within the space of a single hour I
| quickly learned that many of the most common diseases facing
| animals have very little research behind them and a lot of
| unknowns. Which brings me back to one of the main points of the
| author. If the neoliberal approach to research is only going to
| focus on what is profitable to treat, then medical science as a
| whole has backed itself into a dark corner.
| rafaelero wrote:
| There is one simple solution: replication. Stop complaining and
| start replicating.
| chicob wrote:
| After reading this article I find only one problem with it, and
| that is the title.
|
| The problem the authors have so perfectly characterized has
| nothing to do with the emphasis on evidence that medicine
| requires, but on the distortion imposed on the system by large
| pharmaceutical companies.
|
| The reality of the obstacles standing in the way of rigorous
| testing for drug or therapy effectiveness does not make evidence-
| based medicine an illusion.
|
| In fact, the authors actually make a strong argument in favor of
| evidence-based medicine, by stating the need to acknowledge these
| biases. And that the reason for all these biases is greed.
| pmoriarty wrote:
| The article shows how what passes for evidence based medicine
| is an illusion.
|
| The "evidence" is biased and corrupted by corporations, as are
| many of the people who evaluate it, set the standards, and make
| decisions.
| xmprt wrote:
| I think you're misunderstanding the title. It's not that
| evidence based medicine has problems. It's that there are
| problems with how evidence based medicine is currently
| practiced which gives it the appearance of evidence based
| medicine while actually not being anything close, that is, an
| illusion.
| ouid wrote:
| Stop calling it greed. It's corruption and regulatory capture.
| Both of these, unlike greed, are problems that can be solved.
| verisimi wrote:
| > It's corruption and regulatory capture.
|
| Absolutely!
|
| > Both of these, unlike greed, are problems that can be
| solved.
|
| Hmm... I don't see how. Pharmaceutical companies (and all
| other corporations, for that matter) pay the lobbyists to
| write the legislation that is then duly waved through. This
| is to say the governance structure itself is captured.
|
| In fact, I think it always was captured, but only that we
| have laboured erroneously under the idea that it was there to
| help us. And creating that illusion is the job of education
| and corporate media.
|
| Until we are disabused of the idea that government is
| anything other than a parasitical, wealth extraction process,
| that no one has the right to forcibly take another's money
| (tax) and to do so means to be subjugated to a type of
| slavery, that legislation has very little to do with
| morality, that we are given our opinions first at school with
| 18 years or so of indoctrination which is then topped up via
| screens and newspapers - until we recognise that we are
| sovereign beings that will stand up for what is right and
| refuse what is wrong, we're not going to change much.
| twofornone wrote:
| >Scientific progress is thwarted by the ownership of data and
| knowledge because industry suppresses negative trial results,
| fails to report adverse events, and does not share raw data with
| the academic research community.
|
| Not to derail the thread but this nicely encapsulates my
| reservations toward the COVID vaccines, and why I think mandates
| are egregiously unethical. The raw clinical trial data is still
| effectively a secret between pharma and the FDA, and both are
| under immense financial/political pressure to release a "safe and
| effective" product, not to mention the incestuous relationship
| between the ostensibly independent FDA and big pharma.
| sebmellen wrote:
| I find it very discomfiting that anyone suspicious of the
| COVID-19 vaccine _(by that I mean the COVID vaccine /spike
| protein in particular)_ is branded as anti-vax. I say this as a
| vaccinated person who caught a heavy bout of COVID. I suppose
| I'm grateful for the vaccine, but mandates scare me.
| tricky777 wrote:
| as chistians say, "turn the other cheek". (labeling did not
| made much harm, dont get too ivested in that)
|
| reality is, that we can't have policy/public sentiment that
| is nuanced. (I heard it breaks the timecontinuum)
|
| Find the silver lining and move on. I'm just glad that, a lot
| of people are in pro-vaccine side overall. While in your case
| it is a bit of mob mentality (mostly appeal to authority +
| optimism + jugde_dissagreeing_side), in the long run "pro
| vaccines" is (even if only on average) leaps and bounds and
| couple of parsecs better than "no vaccines".
| [deleted]
| specialist wrote:
| Do you school-aged children? Pets?
| simonh wrote:
| To a point that's understandable, based just on trials it's
| reasonable to be skeptical of the results. However once the
| vaccines have been in mass distribution and there is copious
| evidence of their efficacy and the extreme rarity of adverse
| affects, I don't think it's reasonable anymore.
|
| The mandates only came in once enough of the population had
| been inoculated to make a requirement possible. At that point
| the initial trials are a footnote compared to the results from
| mass vaccinations. IMHO it's just not reasonable for that
| objection to carry any weight. There may be other reasons, of
| course.
| cuspy wrote:
| The problem with this line of reasoning is that there is a
| huge difference between controlled trials (which are
| obviously imperfect themselves) and post-hoc analyses of
| uncontrolled real-world outcomes. There's a big leap of faith
| in trusting our public health authorities' ability to
| accurately measure and faithfully represent the real
| situation.
|
| Just to name one small issue, our only measurements of
| vaccine efficacy are case counts, covid hospitalizations and
| covid deaths. Each one of these measurements is confounded by
| population-level differences in testing rate, testing polices
| (ie routine testing on entrance to hospital), PCR cycle
| count, and many other factors. There is no longer a monitored
| control group, so we can't ever account for any group-level
| differences or confounds. I've seen no attempt to address
| these issues.
|
| We also have no access to reliable data about confirmed
| adverse effects. A year later, it is still very hard for a
| person to quantitatively assess his/her own age-stratified
| risk/benefit tradeoff, even with the confounded efficacy
| measures.
|
| So, given all that, why isn't skepticism reasonable anymore?
| simonh wrote:
| I really don't see why there is a huge leap of faith with
| coronavirus vaccines, but not with the many safe, effective
| vaccines and medications we all benefit from throughout our
| lives.
|
| Have you always felt this way about the medical profession?
| Have you any specific reasons to doubt the medical
| profession and it's institutions, across many nations and
| accreditation agencies, now in particular?
| fabian2k wrote:
| The effect of vaccinations is huge here, especially if we
| focus on deaths and hospitalisations in elderly people.
| There are of course issues with using data that only
| observed and not part of a strict randomized and blinded
| trial. But the difference observed in many different
| studies between unvaccinated and fully vaccinated is simply
| so enormous that it doesn't really leave any room for
| doubt.
|
| The effect of the vaccines is so huge that you only have to
| look at a Kaplan-Meier plot and will immediately see the
| huge difference. And we don't have a single study here, we
| have a lot of different ones that all indicate that the
| vaccines are very effective and safe.
| cuspy wrote:
| I would trust sound data and transparent analyses showing
| age-stratified risk analyses if they existed. With all
| respect, what you just wrote is essentially hand-waving
| and talking past what I wrote. High effectiveness for
| elderly people (which I find plausible but also still
| deeply confounded by testing rate differences) in no way
| justifies mandates for people in their early 20s.
|
| In some proportion of hospitals, when someone who is not
| vaccinated goes to hospital for any reason, they are
| tested for COVID-19. If found positive this is counted as
| a COVID-19 hospitalization. We have no access to the
| precise rate of these incidental hospitalizations. In
| some of these hospitals, it is the policy that vaccinated
| people who go to the hospital are NOT routinely tested
| unless they have symptoms. If this is the policy at a
| substantial number of hospitals, it could dramatically
| change the "effect size" of the measurements that we are
| talking about. The same issues essentially applies to
| COVID-19 deaths and cases.
|
| Large effect size alone generally isn't convincing when
| you're using such fundamentally confounded sampling
| procedures, merged age-groups with wildly different risk
| profiles, and data aggregated across long time-windows
| with different population sizes.
| tricky777 wrote:
| Even if this particular vaccine was ok (and I still feel fine
| after the booster), the process seems shady if results are
| kept secret (having good processes is very important.
| remember "checks and balances")
| simonh wrote:
| Trial data is kept confidential due to the risk that access
| to the data or information about it by research teams could
| influence or bias the design or conduct of further trials.
| This is routine in medical trials based on hard won lessons
| from previous problems due to biased trials and conflicts
| of interest.
|
| It might seem shady if you don't know the reasons for it
| (what are they hiding?). I understand that, but the fact is
| this is standard practice and releasing the raw data would
| be reckless and irresponsible.
| twofornone wrote:
| >and the extreme rarity of adverse affects, I don't think
| it's reasonable anymore
|
| There's a major caveat here, sudden and obvious adverse
| effects are rare. The subtle and possibly long term ones are
| still unknown. It took some 5-10 years before Thalidomide was
| found to cause severe birth defects, for example.
| simonh wrote:
| Thalidomide isn't a vaccine so that hardly seems relevant.
| We have extensive experience with many vaccines across huge
| populations and no reason to expect these ones to be any
| more dangerous than the others. Also it seems somewhat
| unlikely that any possible side effects, if they were to
| manifest, could possibly be as bad as millions of deaths
| and tens of millions with long term complications .
|
| The vast majority of people objecting to covid vaccines
| have no history of vaccine denial, and no good reason to
| suspect the covid vaccines are particularly dangerous
| compared to the many vaccines they have accepted previously
| without a thought or any interest in their history, testing
| or method of action. It's politically motivated from start
| to finish and has nothing to do with the medical facts.
| fabian2k wrote:
| It took 4 years for thalidomide until it was removed from
| the market. And this is the text book case that triggered
| more stringent regulation for drugs.
| _jal wrote:
| > The subtle and possibly long term ones are still unknown
|
| So just say you won't take it and be done, because there is
| no mechanism that can satisfy you.
| fabian2k wrote:
| The original clinical trials are essentially irrelevant now for
| the vaccines, we have a lot more data from using the vaccines
| in the real world now. Of course that data is not randomized
| and double-blind, but because of the sheer numbers you can
| still do very good science on this. The original trials are
| also simply outdated because the virus changed, we're several
| big variants later now.
|
| There are also more agencies than just the FDA that approved
| these vaccines, if you don't trust them specifically.
|
| Publication bias is a real issue, and I'm annoyed that all
| efforts to reduce it seem to be rather ineffective. The ideas
| behind requiring registration of trials is good, but it doesn't
| do much if you don't actually police the rules. But the COVID
| vaccines got such enormous amounts of attention that it really
| doesn't matter in this specific case.
| twofornone wrote:
| > Of course that data is not randomized and double-blind, but
| because of the sheer numbers you can still do very good
| science on this
|
| But is the science being done "good" considering that the
| political and social pressures around reporting of negative
| results/adverse effects still exists? How do you get good
| data on adverse events if vaccine recipients don't even think
| to correlate strange symptoms x weeks or months post
| vaccination with the vaccine? How would you detect an
| autoimmune disorder with vague and nonspecific symptoms, for
| example, when doctors also are unwilling or unable to collect
| relevant data out of a combination of bias and ignorance?
|
| It's a double whammy, because of the novelty we don't know
| exactly what we're looking for, and because of
| stigma/political pressure we are arguably not looking hard
| enough. Being labeled an anti-vaxxer is effectively career
| and social suicide, how many researchers are willing to stick
| out their necks, especially when rigorous proof would take
| years of research and funding to aggregate?
| fabian2k wrote:
| There was a very rare side effect in the Astra Zeneca
| vaccine that was discovered quite quickly. Not in the
| original trials as they are simply not powerful enough to
| detect side effects that rare, but in later observations.
| We also pretty quickly figured out that the risk is age-
| related, and many regulating authorities reacted based on
| that and adjusted the recommendations.
|
| To me this is pretty good evidence that the existing
| mechanisms for detecting rare side effects work in general.
| One can argue about the details in this case on how exactly
| the authorities responded, and I think also reasonably
| disagree on how to weigh the risk/benefit in this
| particular case for specific age groups. But those are much
| more difficult questions based on inherently fuzzy data due
| to the low frequency of this serious side effect. But the
| detection itself worked well, and also produced very quick
| reactions.
| hgomersall wrote:
| What? There was lots of work looking at side effects of the
| vaccines. The AZ vaccine was paused in several places
| whilst rare and unexplained blood clots were better
| understood. It was only because the huge numbers of
| recipients that such information was available. What point
| are you trying make? That somehow scientists are not
| willing to raise problems with the vaccines? That's
| demonstrably not true.
|
| What is also demonstrably true is that the death rate from
| COVID is now negligible for those vaccinated. Might there
| be some super rare interaction we don't know about? For
| sure, but there's also as likely to be super rare
| interactions with COVID itself, or whatever crank treatment
| of choice replaces a vaccine.
| rscho wrote:
| Evidence-based medicine, more than the indeed important issues
| raised in the article, is mostly impaired by the absolutely
| abysmal average quality of clinical research papers. The
| absolutism of higher-ups combined with their unrivalled (in the
| scientific world) statistical ignorance is hurting science more
| than anything else. And there's a reason to that: MDs are not
| scientists. We're highly-skilled workers, and more of the blue-
| collar kind.
| dr_dshiv wrote:
| Disagree. Think your standards are too high.
| mananaysiempre wrote:
| > We're highly-skilled workers, and more of the blue-collar
| kind.
|
| While it's a bit of a problem that sometime during the last
| century a skilled profession got equated with a research one (I
| remember hearing somewhere that a commercial pilot's education
| costs about as much as a tenured professor's, and it seems
| plausible to me), there's also the fact that the people you
| call "workers" are more distanced from research than they used
| to be; my impression is that this is even stronger among
| engineers than it is among medical professionals, but I can
| hardly claim any deep knowledge here.
|
| MIT is originally an engineering college, so is the Ecole
| polytechnique, and the Ecole normale is a school for
| bureaucrats. Cauchy's seminal work on wave propagation was
| presented at the French academy, had an epigraph from Virgil
| ("how many waves / come rolling shoreward from the Ionian
| sea"), and was signed by "Mr. Augustin-Louis Cauchy, road and
| bridge engineer" (this being the title the Polytechnique
| awarded him).
|
| It used to be normal (AFAIK) for articles in medical journals
| to be essentially "hey, look what a weird thing happened with
| this recent patient of mine", and some of seminal (if not the
| most high-brow) mathematics journals started as "hey, solve
| this problem I have recently done / want to know the answer to
| ... if you're not chicken to try".
|
| What happened to all of this was, in a word, specialization--
| necessitated in part by the exhaustion of low-hanging fruit and
| raising of epistemic standards, so not entirely pointless, but
| I have to admit the comparative conservatism of medicine in
| this regard always looked more hopeful to me than the, at
| times, raging anti-intellectualism of engineers or the fiddly,
| illogical, invented world of law.
|
| Certainly medicine is more engineering than science in that it
| is driven more by immediate goals than by the pursuit of truth
| alone (not the only possible definition of science, but a
| useful distinction when it comes to the feeling of the field,
| cf the 50s adage about physics and military physics being like
| music and military music). And I certainly won't say you're
| wrong. But I'm sad, and I can't help feeling the drive for
| industrialization has done a disservice to us, scientists and
| craftsmen both.
| pmoriarty wrote:
| _" raging anti-intellectualism of engineers"_
|
| What makes you think engineers are anti-intellectual?
|
| Engineering is an intellectual discipline, after all.
| lazide wrote:
| I suspect the poster is referring to anti the type of
| Intellectualism which is pure theory (or similar) and not
| application focused.
|
| Which I'd agree with - most Engineers tend to hate that
| kind of thing.
| mananaysiempre wrote:
| > What makes you think engineers are anti-intellectual?
|
| FWIW, I've encountered the thing I call anti-
| intellectualism here among experimental physicists as well,
| and even in some theorists and mathematicians as well, to
| varying degrees. I don't mean being stupid or not using
| your brain for work; I'm sure some of the people I'm
| thinking of here are much smarter than me and/or have
| contributed much more to society than I ever will. I'm not
| thinking of _all_ engineering or science people, either;
| the maths teacher I had in high school is perhaps the
| strongest opposite of this stereotype I know.
|
| What I mean is a certain lack of wonder and ... suspension
| of disbelief(?) when it comes to other kinds of
| intellectual pursuits (sciences, arts, humanities,
| philosophy, mathematics), like a feeling you're doing Real
| Work while those other quacks do pointless things to amuse
| themselves, and are not even particularly successful at
| that. "Shut up and calculate", if brought out among people
| who are past the basic level of understanding of the
| subject in question, is a manifestation of this (even
| though the originator of the saying in the context of
| quantum mechanics, David Mermin, is now a proponent of the
| "quantum Bayesianism" school of philosophical thought).
| Lest it seem that I'm dunking on physicists here, the "Two
| cultures" essay and Hardy's "Apology" also contain some of
| this.
|
| If you've read the book, the shortest definition is perhaps
| to say that my "anti-intellectualism" is the opposite of
| _The Glass Bead Game_ , even if Hesse intended it as his
| anti-Enligtenment manifesto.
|
| And I cannot say this sort of skepticism is _always_ wrong
| --that way lies _Fashionable Nonsense_ and New Age
| mysticism, and epistemic relativism scares me like little
| else. We do owe some advances in quantum foundations to New
| Age people, though, so sneering in that direction might not
| be right either.
|
| (If you think that this anti-intellectualism thing and the
| complement of the hacker spirit seem remarkably similar,
| you're right.)
| pmoriarty wrote:
| I'd call that intellectual snobbery and scientism rather
| than anti-intellectualism.
|
| This is especially evident towards fields one knows
| little about, towards the so-called "soft sciences" and
| the humanities.
| kelseyfrog wrote:
| It's easy to find them. Let us call them out using the
| siren song.
|
| Psychology and sociology are just as much sciences as
| mathematics, computer science, physics, chemistry, and
| biology.
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